Difference between revisions of "Oesophageal Fistula"

Revision as of 15:28, 15 July 2010

Description

An oesophageal fistula is an abnormal connection between the oesophageal lumen and a structure in its immediate vicinity, most commonly the lungs or other respiratory structures producing a bronocho-oesophageal fistula. In rare cases, fistulae may be congenital but they are usually acquired phenomena. Acquired oesophageal fistulae occur when severe inflammation or disruption of the oesophageal wall leads to perforation and, as this heals, a tract is formed with the respiratory system. Causes of the initial insult include foreign bodies, neoplasia and severe oesophagitis. Passage of oesophageal luminal contents into the respiratory system may result in localised pneumonia, pleurisy and pulmonary abscessation.

Signalment

Cairn terriers may develop congenital fistulae but the condition is generally rare in cats and dogs.

Diagnosis

Clinical Signs

Clinical signs associated with congenital fistulae tend to develop after weaning as solid food is more likely to lodge in the fistula and, depending on the food, it may have a higher microbial load than milk. Acquired fistulae tend to develop later in life and are associated with an injury to the oesophagus. Clinical signs are usually associated with the respiratory system and gastro-intestinal signs are actually rare:

Coughing, especially soon after eating or drinking.
Dyspnoea
Signs of (aspiration) pneumonia, including dyspnoea, tachypnoea, pyrexia and coughing.
Regurgitation,

Diagnostic Imaging

Survey radiography: localized lung patterns (alveolar, bronchial and/or interstitial) mainly in right caudal, right intermediate and left caudal lung lobes. The oesophagus appears normal unless a foreign body can be observed.

Contrast radiography: can provide definitive diagnosis using a barium sulphate oesophogram. Avoid iodinated contrast agenst as they are irritants to the lungs.

Endoscopy: also allows definitive diagnosis if the fistula is large enough to be visualised.

Treatment

Surgical excision and repair. A partial or complete lung lobectomy of the affected lobe is advocated.
Postoperative broad spectrum antibiotics

Prognosis

Guarded in the presence of secondary complications otherwise good.

References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

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-{{review}}
+{{unfinished}}
-{{cat}}
+==Description==
-{{dog}}
+An oesophageal fistula is an abnormal connection between the oesophageal lumen and a structure in its immediate vicinity, most commonly the lungs or other respiratory structures producing a '''bronocho-oesophageal fistula'''. In rare cases, fistulae may be congenital but they are usually acquired phenomena.  Acquired oesophageal fistulae occur when severe inflammation or disruption of the oesophageal wall leads to [[Rupture of the Oesophagus|perforation]] and, as this heals, a tract is formed with the respiratory system.  Causes of the initial insult include [[Oesophageal Foreign Body|foreign bodies]], [[Oesophageal Neoplasia|neoplasia]] and severe [[Oesophagitis|oesophagitis]].  Passage of oesophageal luminal contents into the respiratory system may result in localised pneumonia, pleurisy and pulmonary abscessation.
-==Typical Signalment==
+==Signalment==
-*Cairn Terrier for congenital fistula
+Cairn terriers may develop congenital fistulae but the condition is generally rare in cats and dogs.
-*Rarely seen in cats and dogs
-==Description==
-An abnormal connection between the oesophageal lumen and surrounding structures most commonly involving the lungs or other respiratory structures. Can be congenital (rare) or acquired. With congenital fistulae, the animals usually have oesophageal foreign bodies. Acquired oesophageal fistulae usually result from foreign bodies (usually bones and grass seeds) leading to lumen perforation and inflammation spreading into adjacent tissues. Secondary complications include:
-*localized pneumonia
-*pleuritis
-*pulmonary abscessation
 ==Diagnosis==
 ===Clinical Signs===
-*Congenital fistulae develop signs post weaning
+Clinical signs associated with congenital fistulae tend to develop after weaning as solid food is more likely to lodge in the fistula and, depending on the food, it may have a higher microbial load than milk.  Acquired fistulae tend to develop later in life and are associated with an injury to the oesophagus.  Clinical signs are usually associated with the respiratory system and gastro-intestinal signs are actually rare:
-*Acquired fistulae develop in later life
+*'''Coughing''', especially soon after eating or drinking.
-*Coughing
+*'''Dyspnoea'''
-*Dyspnoea
+*Signs of '''(aspiration) pneumonia''', including dyspnoea, tachypnoea, pyrexia and coughing.
-*Regurgitation
+*'''Regurgitation''',
-*Lethargy
-*Anorexia
-*Fever
-*Weight loss
 ===Diagnostic Imaging===
 '''Survey radiography''': localized lung patterns (alveolar, bronchial and/or interstitial) mainly in right caudal, right intermediate and left caudal lung lobes. The oesophagus appears normal unless a foreign body can be observed.